Boivin M, Flourie B, Rizza R A, Go V L, DiMagno E P
Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota.
Gastroenterology. 1988 Feb;94(2):387-94. doi: 10.1016/0016-5085(88)90426-x.
A partially purified amylase inhibitor given with a single meal causes maldigestion of carbohydrate, increases delivery of carbohydrate to the ileum, and reduces postprandial plasma glucose. To determine the effect of more prolonged administration of the inhibitor on gastrointestinal function and carbohydrate tolerance, we studied 6 non-insulin-dependent diabetics (3 previously treated with oral agents and 3 treated with diet alone) for 3 wk while they ate a weight-maintenance diet. Patients taking oral agents continued them during the first week. During the second week, 4-6 g of the inhibitor was given with each meal. Capillary blood glucose concentration was measured before each meal and 90 min postprandially. On the last day of each week venous blood samples for glucose, hormones, and lactic acid analysis and a quantitative stool culture were obtained. Total carbohydrate absorption was estimated by comparing postprandial breath hydrogen on study days 7, 14, and 21 with breath hydrogen after ingesting 15 g of lactulose on days 0, 15, and 22. There 24-h stools were collected and weighed at the end of each week and analyzed for carbohydrate, lactic acid, short-chain fatty acids, pH, dry matter, amylase, and fat. The inhibitor significantly (p less than 0.05) reduced postprandial plasma glucose, C-peptide, insulin, and gastric inhibitory polypeptide concentrations, significantly increased (p less than 0.05) breath hydrogen excretion, and caused carbohydrate malabsorption. Diarrhea occurred the first day the inhibitor was ingested, but thereafter cessation of diarrhea was associated with changes in the metabolism of carbohydrate by colonic flora. As the amylase inhibitor improves carbohydrate homeostasis and is not associated with continuing diarrhea, it may be a useful adjuvant in the treatment of patients with non-insulin-dependent diabetes mellitus.
单次进餐时给予部分纯化的淀粉酶抑制剂会导致碳水化合物消化不全，增加碳水化合物向回肠的输送，并降低餐后血浆葡萄糖水平。为了确定更长期给予该抑制剂对胃肠功能和碳水化合物耐量的影响，我们对6名非胰岛素依赖型糖尿病患者（3名先前接受口服药物治疗，3名仅接受饮食治疗）进行了为期3周的研究，期间他们食用维持体重的饮食。服用口服药物的患者在第一周继续用药。在第二周，每餐给予4 - 6克抑制剂。在每餐饭前和饭后90分钟测量毛细血管血糖浓度。在每周的最后一天，采集静脉血样进行葡萄糖、激素和乳酸分析以及定量粪便培养。通过比较研究第7、14和21天的餐后呼气氢气与第0、15和22天摄入15克乳果糖后的呼气氢气来估算总碳水化合物吸收情况。在每周结束时收集24小时粪便并称重，分析其中的碳水化合物、乳酸、短链脂肪酸、pH值、干物质、淀粉酶和脂肪。该抑制剂显著（p < 0.05）降低了餐后血浆葡萄糖、C肽、胰岛素和胃抑制多肽浓度，显著增加（p < 0.05）了呼气氢气排泄，并导致碳水化合物吸收不良。在摄入抑制剂的第一天出现腹泻，但此后腹泻停止与结肠菌群碳水化合物代谢的变化有关。由于淀粉酶抑制剂可改善碳水化合物稳态且与持续性腹泻无关，它可能是治疗非胰岛素依赖型糖尿病患者的一种有用辅助药物。
